A message from the Chair and Chief Executive

It is clear that something really significant is happening in the Trust. In the last six months
of 2007/08 we have seen a dramatic improvement in performance against national
standards, significant improvements in our financial position and a fall in waiting times.

These changes, coupled with very big changes in how services are to be delivered in the
latter part of 2008, suggest that the Trust is using all of its resources much better than
previously, with notable improvements in quality and productivity.
These successes have been achieved by the hard work, commitment and creativity of our
staff.

This is just the start and there is much more to do before we have the services that
we all want; but progress is being made quickly and visibly.

Improvements are Happening Quickly

A&E performance has moved from being amongst the worst in the country to being amongst the best.

We are cancelling far less operations than recently, particularly at St Albans

A Period of Change

The Trust entered the 2007/08 year on the back of two consecutive years of being rated by the Healthcare
Commission as weak on the use of resources and weak on the quality of services. This double weak rating was a threat to the future of the Trust and
significant changes were required. As late as autumn, the indications were that the Trust
was still at significant risk of another weak/weak rating. Jan Filochowski joined the Trust at the beginning of November 2007 with the task of making
basic performance improvements for the last five months of 2007/08 and to continue to
develop the short to medium term priorities.

The Trust's focus therefore changed from November 2007 when the emphasis was on getting
the basics right. From thinking that we may have already failed against the Healthcare
Commission targets for 2007/08, we now think it is likely that we will be awarded a 'Fair'
on use of resources and a 'Fair' on quality of services when the results are announced in
October 2008. This is a rapid advance in a relatively short time and will need to be
maintained and further improved.

Our People

We recognise it has been a difficult year for staff. We have done some things well, but
there has been a lack of clarity around people's roles and responsibilities. The Trust has
tried to put that right and emphasised its double focus on:

Patient Safety – preventing healthcare infections is our number one focus and priority
as safety in all we do is the key.

Delivery – ensuring we actually deliver what we promise quickly so we can deliver the
very best services for the people of west Hertfordshire

Our performance

In recent years we have not performed at the highest levels, hence the ratings from the
Healthcare Commission for 2006/07 assessing our performance as “weak/weak”. If we are
to have the future we deserve, this had to change.

A Few Other Headlines

C. diff has been brought under control. There has been a remarkable and continuing
improvement since the first half of 2007, when levels were very high. MRSA cases are
also reducing, but we need to get them down further. The introduction of isolation
wards in the Trust has had a real and lasting effect.

Our A&E performance moved from being one of the worst in the country in the first six
months of 2007/08 to being right up where it should be and we are now consistently
seeing more than 98% of patients within the four hour national standard.

Keeping people in hospital longer than is necessary, delayed discharges, is a serious
problem but we are tackling it with our NHS partners. Numbers are still too high but
they are considerably lower than last year.

A new centre for patients needing planned surgery was opened at St Albans in
September 2007. This is a good facility based upon a good idea, but it ran into major
operational difficulties at the start. Getting its problems sorted has been one of our
biggest and immediate concerns and significant improvements had been made by the
end of March 2008.

Big changes are underway as the Trust reforms and modernises with the opening of an
Acute Admissions Unit (AAU) at Watford in early 2009. This unit will herald a real
step-change
for patients. It will provide excellent medical care, early and accurate assessment
of their needs and prompt provision of the right and appropriate care. The effect of all
this will be improved quality of services and improved use of resources.

Foundation Trust application

At the October 2007 meeting the Board made the decision to apply for Foundation Trust
status. The process to achieve FT status is a long and complex journey. Our five year
Integrated Business Plan and Long Term Financial Model were submitted to the Strategic
Health Authority (SHA) at the end of January 2008. The process will see the Trust going to
public consultation in September of this year and accreditation as an FT in 2009.

And Finally....

There is a sustained and significant improvement happening in the Trust. The
improvements recorded in this report have been achieved by the hard work,
determination and creativity of people working in and with the Trust. We know that
everyone involved has the very difficult task of making improvements for the future whilst
running today's services.

Let us end by outlining a couple of final messages

Firstly, nothing is more important for the Trust than preventing and controlling healthcare
acquired infections. We have transformed our performance in controlling C.diff. More
needs to be done on MRSA, but we are bearing down on this. At the present time, nothing
is more important for us and nothing is more important for the patients of west
Hertfordshire.

Secondly, we were amongst the worst in the country for waiting times in A&E. Today we
are consistently at or above the national target of seeing patients within 4 hours. How
long people wait in A&E is one of the main ways in which they judge their local hospitals.
That's exactly as it should be.

We intend to ensure we make these improvements permanent and that we become the best Trust we can possibly be for the people of west Hertfordshire.
NHS Foundation Trusts are a fundamental part of the current NHS reform programme. They reflect the move from
a centrally managed service towards one that is managed locally and is therefore more responsive to patients.
Foundation Trusts are authorised and monitored by Monitor – the Government's Independent Regulator of NHS
Foundation Trusts.